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Location: The Liberator, somewhere deep in Federation space, United States

Orac is but a humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. That Orac has chosen his pseudonym based on a rather cranky and arrogant computer shaped like a clear box of blinking lights from an old British SF show whose special effects were renowned for their early 1980's BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction for television ever produced, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.) Orac tries to keep his insolence respectful, but admittedly sometimes fails in the cases of obvious quackery and pseudoscience, attacks on him, very poor critical thinking skills, bigotry, and just general plain stupidity.

What is Respectful Insolence?

Respectful Insolence is a repository for the ramblings of the aforementioned pseudonymous surgeon/scientist concerning medicine and quackery, science and pseudoscience, history and pseudohistory, politics, and anything else that interests him (or pushes his buttons). Orac's motto: "A statement of fact cannot be insolent." (OK, maybe it can be just a little bit insolent.)

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Insolent Disclaimer

This is a personal web log, reflecting the sometimes prickly opinions of its author. Statements on this blog do not represent the opinions of anyone other than the author. They most definitely do not represent the opinions or position of the author's hospital, university, surgical practice, or partners. The information on this blog is intended for discussion and entertainment purposes only and not as recommendations on how to diagnose or treat illnesses. Any personal medical issues the reader may have should be referred to the reader's physician. If the reader freely chooses to follow the opinion of a pseudonymous blogger like the author (who has also not done a proper history or physical examination and whose credentials cannot be verified) over that of his or her own personal physician, it is the reader's decision alone, for which the reader must bear full responsibility.

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Tuesday, July 26, 2005

It looks like Orac attracted another one

One of the occupational hazards of blogging is that sometimes people don't like what I say. I've had alties and creationists take their best shots and attracted some pretty fierce attacks in the comments section of various posts. Early on, I had a hard time letting any criticism that I detected pass without response. As Respectful Insolence got a little bit bigger and better established, leading to more people taking potshots at me, I learned to let it slide--most of the time, anyway. The rare times I haven't "let it slide" sometimes end up in the "Orac knows snark" section of my sidebar.

This time I don't feel like letting it slide. I admit it; sometimes an attack annoys me just enough that, if I happen to be in the right (or, more appropriately, wrong) mood, I have a hard time resisting making a response and administering a smackdown, even though my better nature tries frantically to warn me not to waste my time, like the robot in Lost in Space yelling, "Danger, Will Robinson!" Maybe it's because I had a rough day in clinic yesterday. Maybe it's because, for whatever reason, my tolerance for such silliness is lower as I write this than it usually is. Maybe it's because I was watching the remake of Dawn of the Dead on cable as I settled down to come up with today's post? Who knows? (What my occasional inability to resist giving these people the oxygen of attention--to "feed the troll," as we used to say on Usenet--says about me, I will leave the reader to decide; but sometimes a blogger's just gotta do what a blogger's gotta do. Besides, it's been two months since anyone's annoyed Orac enough to motivate him to lay down some of his trademark Respectful Insolence.) In any case, via e-mail I've become aware of just such an attack. Apparently a blogger named Karl doesn't like me very much, or at least my message when it comes to mercury-autism conspiracy-mongering. He also seems to like Skeptico or Autism Diva even less than me, viewing us all as "blowhards." I knew it was going to be a case of the pot calling the kettle black right away, though, when Karl started out:

As I kept digging into this Mercury/autism debate over the weekend, the more it started to bug me. And not just because of the possibility a government decision may have led to the poisoning of massive swaths of children. But because I loathe blowhards, and the more I read, the more I found the debate dominated by an odd collection of self-professed "skeptics" and experts.

Hmmm. By that criterion, it would appear that Karl must have a lot of self-loathing to deal with. As I started to read, I was wondering if Karl had perhaps found some major flaws in my arguments or those of Skeptico or Autism Diva that had angered him to the point that he felt that he had to respond in such an angry, sarcastic fashion, much the way I did when I first encountered the RFK, Jr. article.

I should have known better.

Instead, what followed was nothing but pure ad hominem attack, utterly devoid of a single intelligent piece of analysis, citation of a study, or reasoned argument showing the flaws in facts or logic that any of the three of us used. "Pot kettle black" indeed! For example:

But on the flip-side of that coin is a web of bloggers who fancy themselves skeptics and autism experts because they can post hyperlinks on blogger.com. Wherever someone pops up to suggest a Thimerosal/autism link, there they are, assailing & attacking like foamy mouthed yapping little hyenas.

They're like the Jessie Jackson of Mercury & Autism. Always hanging around. Not really experts. Most have no real credentials in the field. But golly, do they swarm and sting when someone suggests big pharma and Uncle Sam might have fucked up.

Being active on the issue - running sole-purpose blogs focused on an honest debate, the welfare of humanity, and data integrity - that's one thing. But the more I read these people's ramblings, the more I smelled something. And it wasn't honest skepticism.

Someone like Karl lecturing me on what what "honest" skepticism is reminds me , well, an entirely different Karl lecturing on avoiding leaks. Karl's also using a straw man fallacy. None of us has claimed or argued that Uncle Sam or big pharma has been above reproach. Indeed, whether or not Uncle Sam or big pharma has been perfectly well behaved or not has little to do with whether the data does in fact support a link between thimerosal-containing vaccines and autism anyway. Vague conspiracy theories are tempting and fun (how many websites and blogs would disappear virtually overnight if such lunacy didn't exist?), but rarely shed any light on anything other than the paranoia behind them (unless there is real evidence of a coverup, which neither Karl nor even RFK, Jr. can produce). As they say, data talks and bullshit walks, but Karl doesn't seem to want to address the data. In fact, he assiduously avoids addressing the data, resorting instead to ad hominem attacks, after this appeal to ignorance:

Blowhards are always absolutists. Real, honest people don't fucking know. In fact the more an honest person learns, the more they realize they don't know. Therefore, if you actually know anything, you should be fucking uncertain and petrified.

Wrong again, Karl. Even if there is uncertainty, it's burying your head in the sand to say we should be "fucking uncertain and petrified." The uncertainty level about this issue is simply not high enough to justify your Chicken Little response. The Canadian and Danish studies, among others, show that it is highly unlikely that there is a link between mercury and autism. Do they entirely rule out a small effect of mercury in susceptible individuals? Not completely. But they do pretty well refute the contention of some activists that autism is a "misdiagnosis for mercury poisoning." In fact, contrary to Karl's rant, none of us three are absolutists, as a perfunctory reading of our posts on the subject would reveal to a truly neutral observer. I suggest that Karl read this or this and recall what I said (plus variants of the same thing on other occasions) if he doubts me:

For obvious reasons, it's impossible ever to do the gold standard study about this issue: a double-blinded randomized control trial comparing vaccination of babies with vaccines containing thimerosal and vaccines not containing it and follow the children prospectively to see if the babies receiving vaccines with thimerosal have a higher rate of autism than those receiving thimerosal-free vaccines. So what's the next best thing? Good epidemiological evidence has a way of trumping all the theoretical concerns, cell culture experiments, and even animal data, and the removal of thimerosal from vaccines two years ago provides an epidemiological experiment that is seldom possible to do with other diseases. It's a golden opportunity to test once and for all the hypothesis that autism is caused primarily by mercury in thimerosal in vaccines. If, after a decade of no thimerosal in vaccines, austism rates do not decline, that would be very strong evidence that mercury in vaccines is not and was not the cause of autism. In such as case, it would be very difficult indeed to say that there is a link between the two.

Yep. I sure sounded like a rigid dogmatic "blowhard" there, didn't I? How is what I've been saying any different from what Karl seems to approve of as one legitimate view:

Some suggest there's no link now, but note we need to watch autism levels to be sure.

In substance, what I said isn't different, other than in emphasis (namely, in that I express doubt that there will be evidence of a link in the future). But that didn't stop Karl. He apparently also missed this one by me:

Finally, I realize what I've said may have sounded dismissive, but it wasn't. It is a natural desire to look for causes for illnesses like autism or for people to blame, and, even with my skepticism, I wouldn't bet the farm that I might not be tempted to take the same path if I were ever to have an autistic child.

Gee, I sounded really absolutist there, didn't I? I'm sure it must have been a simple oversight on Karl's part that he didn't see the above or any of a number of qualifying statements I've made over the two or three months that I've been blogging on this particular topic. Yeah, that must be it.

Karl also can't resist throwing out a lot of other red herrings, his favorite seeming to be this little gem about Skeptico:

The way he rails against Kennedy reminded me of the absolutist vitriol fired at Michael Moore by free market fanatics. A google search of the name he uses to pen his reviews shows he contributed to the piece that circulated thrashing Moore's Columbine film. Why does that matter? I think his Kennedy tirades show his political stripes. He probably doesn't like Kennedy here because he's saying the same thing Moore repeatedly says:

Corporate America is fucking you.

Uh, no, Karl. The reason Skeptico doesn't like RFK Jr.'s Salon.com article is the same reason I've been lambasting RFK Jr. It's because RFK, Jr. misrepresents the data, confuses correlation with causation (his most egregious example being his repeated claims that autism was unknown before thimerosal-containing vaccines were introduced in the 1930's when a simple reading of the history of autism shows that there were no specific diagnostic criteria for autism before 1943 and that there are many descriptions of autistic-like syndromes from the 18th and 19th centuries), and intentionally feeds hysteria. (Hmmm. Come to think of it, maybe comparing RFK Jr. to Michael Moore isn't completely inappropriate.) It's the same reason both of us get annoyed by "intelligent design creationists" and quacks. Skeptico's politics are irrelevant (as are mine, yours, or even RFK Jr.'s, for that matter). What is relevant are our arguments and the data and reasoning we use to back them up. Really, Karl, if you want to be taken seriously, you need to address those, not speculate about Skeptico's politics. It's not even a matter of politics. I can easily cite a prominent lefty blogger who concluded that RFK Jr. is full of it, and a self-proclaimed flamingly liberal blogger who also doesn't buy into RFK Jr.'s fearmongering.

Now, on to Karl's most egregious ad hominem attack, this time about Autism Diva:

Is she Pharma astroturf (bogus blogs or PR designed to sway public opinion by pretending to be public opinion)? A high functioning autistic (or the mother of one) who can't stand the idea her "unique snowflake" personality might be the result of mercury poisoning? I'm still trying to decide. An expert? Not so much. Sure gets treated like one though.

Notice that, as was the case with Skeptico, Karl can't or won't address any of her arguments. But this time, besides the usual ad hominem attack that she must be a "pharma shill" (an ad hominem attack much beloved of alties, some of whom can't believe that someone who attacks their pet therapy could ever do so for reasons other than being in the pocket of big pharma), Karl launches another unique attack of a particularly nasty nature, namely his sarcastic crack about the "unique snowflake" personality of autistics.

Oddly enough, Karl probably went the easiest on me. Why, I have no idea. Nonetheless, he seems to have a rather distorted view of my beliefs, claiming I have an "utmost belief in the integrity of the U.S. Government, modern medicine, and the Pharm industry." Uh, no, not exactly, given some of the things I've said about this administration and Bill Frist. I just happen to be a big fan of science and evidence-based medicine, so much so that I've devoted my life to it. Come to think of it, you're using a red herring there again, Karl. What I have is an utmost distrust of people like RFK Jr., David Kirby, and J. B. Handley, all of whom have been demonstrated to exaggerate, distort, and cherry-pick data to come to their predetermined conclusions. Ditto the Geiers, whom you held up as examples of investigators showing a link. Did you know that David Geier owns a company whose purpose is to help parents sue for compensation from the National Vaccine Injury Compensation Board and that Dr. Mark Geier makes a good side living as an "expert witness" in vaccine cases, even though he is not qualified? Did you know that Dr. Geier was rebuked by the FDA for trying to merge data files in a way that would have compromised patient confidentiality and allowed the matching of names to conditions in the database, a breach that led to the revocation of his protocol by his Institutional Review Board? Or that the reason the IOM was not impressed by their findings is because of their shoddy research methods? Did you know that the Geiers are no more "unbiased" than the worst pharma shill you seem to think all of us to be in your fevered little tinfoil hat dreams?

Of course you didn't, because you didn't bother to find out. It wouldn't have fit into your little rant, would it?

At least at the end Karl does say one thing that I agree with:

Do I know autism? Nope.

Karl's made that much abundantly clear. He proudly trumpets his ignorance of the actual facts of the issue and instead seems to take great pride in boasting that he can identify "blowhards." In my book, though, "blowhard" is a good word to describe someone who blusters about things he obviously knows little or nothing about. Please, I encourage everyone to read Karl's article and then those of Skeptico, Autism Diva, and me (not to mention Prometheus and Citizen Cain), and decide for yourself who is and isn't a "blowhard." I never claimed to have the final answer on the question of whether mercury in thimerosal in vaccines causes autism, but I did use my training in science and clinical studies to evaluate the data and come to my conclusions. If Karl wants to try to refute them, he is, of course, perfectly welcome to give it his best shot. Will he, though? Flinging about ad hominems and claims of bias is easy. Looking at the data critically and--dare I say?--skeptically and coming to conclusions based on the it isn't nearly so easy.

I figure these people won't be happy until some quack performs a "study" that finds a "link". They will keep saying "WE CAN'T BE SURE" till they receive the answer they want to hear, just like astrologers, psychics, and the other morons who just can't grasp that there beliefs ain't true. I bet they can't wait to use their amazin' superpowers like confirmation bias and selective data...oh, wait...

Real scientists don't see the need to continue studying this issue, just as we don't need to perform studies on whether or not the Earth is flat.

Yeah, the trouncing was indeed overkill, but every couple of months I seem to have the need to get that sort of rant out of my system.

As for Karl's bragging about the size of his penis, I did originally have a comment in the last paragraph making fun of him for such adolescent bravado (a comment along the lines of "bragging about the size of one's penis says far more about the one doing the bragging than it does about the actual size of his penis") but decided to remove the sentence shortly after I posted. Perhaps that was my one instance of self-restraint in this post. ;-)

Yeah, I'm a bit disappointed. Maybe that's why I came in third, behind you and Autism Diva. ;-)

He's hung up on what he perceives to be your politics, more than anything else, I suspect.

At least you guys are having fun with him in the comments of his post. Poor guy looks like he's about to have a meltdown, Tom Cruise-style. ("I've studied the history of autism; you haven't studied the history of autism!" "But wait, I thought you said you didn't know anything about autism." Heh.)

What Autism Diva doesn't understand is how is that the fact that doing a google search on "Autism Diva" pulls up "Autism Diva -the blog" means that she gets treated like an "expert".

Autism Diva only gets some respect for the fact that she consolidates in one place the real expert references that contradict the nonsense out there on a thousand "autism" websites.

She also gets plenty of nasty comments on and off the blog, and no money for it. Sorry, angry blogger dude, Autism Diva is not "astroturf".

Admittedly, she is the stubborn (dogmatic?) one of "the suspect bloggers" in saying that autism is not caused by thimerosal in childhood shots, not ever.

Mercury can technically cause autism IF the child is exposed to in when her or she is still an embryo. This from the mouth of Dr. Patricia Rodier, who thinks that pesticides look more likely if one is going to look for a teratogen that could cause autism. Rodier has found where thalidomide and valproic acid can also cause brain changes in the embryo that can lead to autism or autism-like traits.

Parkinson's disease is pre-programmed, as Autism Diva understands it, the person is sort of "destined" to get symptoms eventually. Its the same with regressive autism, most likely.

But because the kids get vaccinated around the time that they regress, that's all the evidence that some parents want or need. Also, if they believe it was the vaccines there's someone handy to sue. If they thought it was because the kid was traumatized by the visit from uncle Walter and his tuba, on the other hand...

Doug Flutie, the football player, has a son with a "Childhood Disintegrative Disorder" diagnosis, CDD can cause the child to regress as late as age 10, the regression is dramatic and generally thought to be permanent. It's technically not autism, but is a "pervasive developmental disorder".

Noting Prometheus' blog on logical fallacies, there seems to be a variant of the 'argument from ignorance' commonly employed. Notably that no one can be 100% sure about anything, which Karl uses albeit crudely, but which PhDs (ref http://www.scidemnet.org/Files/KeelanSDN.pdf) in Humanities broaden somewhat to say that uncertainty is so certain that all arguments practically speaking have at least some, if not equal, validity. Karl's argument that everybody is wrong because they don't acknowledge the 'good' arguments Kennedy makes is of the same type. One could claim that this is just ignorance of critical thinking and a sign of a lack of education, either formal or informal (most likely true in Karl's case) but how to explain the PhD?

So that's what happened to Karl. I saw the bit on Skeptico's site, but got distracted by research so I never went back after I commented on his comments. It looks like it got worse (LOL).

For a LJ post on RFK Jrs' appearance on the Daily Show, I did some research into the papers published and only found one study out of 36 articles suggesting a link (the Geiers) - well, there were a few op-ed pieces, but I don't count them as scientific.

It's sad too that I offered to ID or send (if legal) the papers I downloaded, so that they could read the actual studies, but no one ever contacted me.